Maganty Avinash, Kaufman Samuel R, Oerline Mary K, Lai Lillian Y, Caram Megan E V, Shahinian Vahakn B, Hollenbeck Brent K
Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
Clin Genitourin Cancer. 2024 Apr;22(2):10-17. doi: 10.1016/j.clgc.2023.07.001. Epub 2023 Jul 5.
Deciding whether to treat or conservatively manage patients with prostate cancer is challenging. Recent changes in guidelines, advances in treatment technologies, and policy can influence decision making surrounding management, particularly for those for whom the decision to treat is discretionary. Contemporary trends in management of newly diagnosed prostate cancer are unclear.
Using national Medicare data, men with newly diagnosed prostate cancer were identified between 2014 and 2019. Patients were classified by 5- and 10-year noncancer mortality risk. Multinomial logistic regression models were fit to assess adjusted trends in management over time. The primary outcome was management of prostate cancer: local treatment (inclusive of surgery, radiation, brachytherapy, or cryotherapy), hormone therapy, or observation.
Local treatment was the most common form of management and stable across years (68%). Use of observation increased (21%-23%, P < .001) and use of hormone therapy decreased (11%-8%, P < 0.001). After stratifying by 10-year non-cancer mortality risk, observation increased among men with low (22.3%-26.1%, P < .001) and moderate (19.9%-23.5%, P < .001) mortality risk. Conversely, use of treatment increased among those with high (62.8%-68.0%, P = .004) and very high (45.5%-54.1%, P < .001) risk of noncancer mortality. These trends were similar across groups when stratified by 5-year noncancer mortality risk.
Nationally, use of local treatment remains common and was stable throughout the study period. However, while local treatment declined among men with a lower risk of noncancer mortality, it increased among men with a higher risk of non-cancer mortality.
决定对前列腺癌患者进行治疗还是保守管理具有挑战性。近期指南的变化、治疗技术的进步以及政策会影响围绕管理的决策，尤其是对于那些治疗决策具有酌处权的患者。新诊断前列腺癌的当代管理趋势尚不清楚。
利用国家医疗保险数据，确定2014年至2019年间新诊断为前列腺癌的男性患者。患者按5年和10年非癌症死亡风险进行分类。采用多项逻辑回归模型评估随时间变化的管理调整趋势。主要结果是前列腺癌的管理方式：局部治疗（包括手术、放疗、近距离放疗或冷冻治疗）、激素治疗或观察。
局部治疗是最常见的管理形式，且多年来保持稳定（68%）。观察的使用增加（21% - 23%，P <.001），激素治疗的使用减少（11% - 8%，P < 0.001）。按10年非癌症死亡风险分层后，低（22.3% - 26.1%，P <.001）和中度（19.9% - 23.5%，P <.001）死亡风险男性中观察的使用增加。相反，非癌症死亡风险高（62.8% - 68.0%，P =.004）和非常高（45.5% - 54.1%，P <.001）的患者中治疗的使用增加。按5年非癌症死亡风险分层时，各亚组的这些趋势相似。
在全国范围内，局部治疗的使用仍然普遍，并且在整个研究期间保持稳定。然而，虽然非癌症死亡风险较低的男性中局部治疗有所下降，但在非癌症死亡风险较高的男性中却有所增加。
